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Just as abortion and the moment a fetus became a person racked Canadians of an earlier generation, so the end of consciousness and assisted death are vexing this one.

With baby boomers facing infirmity and mortality and the medical community’s burgeoning abilities to sustain life, questions about the withdrawal of care and the right to die have come to the forefront.

The Supreme Court of Canada and B.C.’s top courts are wrestling with cases that raise these concerns, entangled in a thorny thicket of religious beliefs, fundamental rights and health-care policy.

On the one hand, judges are weighing whether those facing debilitating infirmity have a right to say goodbye with dignity.

In June, the B.C. Supreme Court ruled the Criminal Code prohibition against physician-assisted suicide was too broad and discriminated against people with disabilities. But that decision was suspended and the case is before the Court of Appeal.

On the other hand, both the country’s top bench and the province’s senior trial court are considering under what conditions people who display extremely limited signs of consciousness and who are on life support may have treatment withdrawn.

In these cases, doctors think further care is futile, while family members want the men involved kept alive, hoping for a miracle.

With more and more of us face these quandaries, who should we trust to make such choices? This is moral quicksand, and it can swallow families.

When life support is withdrawn, for instance, it is often done not by switching off a machine but by withholding nutrients and fluids. Patients can take days, sometimes weeks to die.

Does anyone want to go like that? Could you sentence mom, dad, a brother or a sister to such an end even when doctors say it’s “best”?

When you contemplate the slowly expiring, still-breathing reality, it makes the language of “care decisions” and a patient’s “best interests” seem Orwellian — especially when medical staff and the rest of us understand that the cost of care over years for these individuals is enormous and resources are stretched to the limit.

And that’s not even to approach the views of the faithful who believe in a “soul” rather than “consciousness,” and the moral imperatives that perspective entails.

A recent Alberta ruling, which led to the death of a two-and-a-half-year-old girl with irreversible brain damage, and the affirming appeal, reflect the present state of the law.

The medical specialists unanimously agreed her condition was hopeless and that no further intervention was warranted.

Her parents, who were responsible for her traumatic injuries, disagreed, raising religious arguments against removing life support — but wanting her kept alive as well to avoid a murder charge!

The provincial director responsible for youth intervened, asking the judge to invoke her parens patriae jurisdiction — the inherent power of the court to step in and protect children and promote their well-being.

Alberta Justice June Ross reviewed the authorities and quoted a British jurist reflecting on an identical dilemma: “The question is not whether it is in the best interest of the patient that he should die. The question is whether it is in the best interest of the patient that his life should be prolonged by the continuance of this form of medical treatment or care.”

Ross observed that the case law reflected a “general societal understanding that a life without awareness and totally supported by machines is not in accord with the best interest of any patient, including a child.”

In other words, sometimes keeping someone alive is doing them an indignity and an injustice.

She added that even the religious rights of the parents were not enough to trump the girl’s “best interest.”

Her decision was upheld by the Alberta Court of Appeal in September, and the Supreme Court of Canada refused to intercede.

As the pending cases make clear, the discussion has only begun.

Still, it is important to remember that each of us while mentally competent can refuse life-sustaining medical treatment.

More of us need to realize that we can and should prepare for the day we can’t make those choices for ourselves.

In addition to a will, everyone ought to consider a representation agreement or other form of legal directive outlining the kinds of treatment you will accept if incapacitated — if you don’t, your loved ones may face an excruciating ordeal.

• • •

The Alberta decisions are available on the court websites or by clicking on the following links:

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